Abstract
Introduction: Iran’s declining fertility rate from 3.95 in 1990 to 1.36 during 2020–2025 has recently raised demographic and socioeconomic concerns. Educational interventions based on the Theory of Planned Behavior (TPB) can promote intentions for timely preconception care (PCC). Thus, this study evaluated such an intervention among couples with delayed subsequent childbearing.
Methods: Using a pre-test/post-test design, this quasi-experimental study was conducted in Jiroft, Iran in 2024. Married couples with one child experiencing delayed subsequent childbearing were recruited from eight healthcare centers randomly assigned to the intervention or control groups (n=56 couples each). The intervention group participated in eight weekly, 60-minute educational sessions based on the TPB, targeting attitudes, subjective norms, and perceived behavioral control toward PCC. The outcomes were measured using a validated questionnaire, assessing intention to engage in PCC. Finally, data were analyzed using paired and independent t-tests and ANCOVA to evaluate intervention effects.
Results: At baseline, participants in the intervention group exhibited moderate-to-low PCC-related scores across awareness (mean±SD: 11.94±2.13), attitude (37.13±4.10), subjective norms (25.96±3.54), perceived behavioral control (19.04±2.08), and behavioral intention (11.13±1.23). Following the structured educational intervention, the intervention group demonstrated statistically significant and clinically meaningful improvements in all outcomes. Awareness increased by an average of 4.03 points to 15.98±1.01, and attitude improved by 4.33 points to 41.46±3.70. Moreover, subjective norms, perceived behavioral control, and behavioral intention rose by 1.75 points to 27.71±3.46, 3.33 points to 22.37±1.70, and 2.77 points to 13.90±0.89, respectively (all paired P<0.001). These enhancements, absent or minimal in the control group, highlight the efficacy of the intervention in substantially elevating knowledge, positive attitudes, perceived social influence, behavioral control, and intentions toward PCC.
Conclusion: The educational TPB-based intervention could significantly improve PCC-related factors and intentions among women with one child and delayed pregnancies. These findings support using theory-driven programs to enhance reproductive health and promote informed childbearing decisions.